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The author claims kinship with certain revisionists of freudian theory: George Mead, Martin Buber, and Harry Stack Sullivan. He seems, however, to offer a new terminology rather than any conceptual novelty. He emphasizes that constitutional as well as environmental factors are important in the evolution of schizophrenia. These constitutional factors involve the primitive thinking and affective states that the older terminology calls primary process. The author does not make clear whether there is a constitutionally better development of primary process in the schizophrenic, or a greater tendency to regress to it because of traumatic fixation, or both. He only states that more attention must be paid to these constitutional factors.
Two types, he says, do not develop frank symptoms until adulthood. Fixation and trauma do not begin until the second year of life, when the child's ego has developed sufficiently to distinguish between object and self, to use symbolization, to anticipate the future, and to assume the roles conferred by significant adults. Parental rejection has a severe effect but may be subtle. The child's image of itself, in keeping with its parents' attitude, is poorly organized and is rejected by it as inferior. In defense, the child represses emotions and withdraws from contact with objects. Another type, the stormy personality, tries forcefully to establish a relation to objects by aggressive, constantly changing maneuvers. This develops a very weak sense of identity. When adulthood requires increasing maturity and integration, these types react to the demand with psychotic mechanisms which seem to offer immediate benefits.